Gifted Issues Discussion homepage Forums Twice Exceptional Had BASC, have report, now what?

Hi.. It's been awhile since I've been around, but I need your help!!

DS 9 (who is also gifted) was diagnosed with Tourette's 2 years ago - very mild, mostly at home, mainly consists of a slight grunt or moan, sometimes accompanied by an eye blink.. The blinks came first, then the vocalization, but the blinks have mostly disappeared now... Happens most often during dinner, watching TV, lying in bed - at school only usually happens when they start writing (which is his least favorite thing to do...)

At teacher conferences in March, teacher mentioned she'd had the counselor come and observe him a few times because he seemed to be having trouble interacting with other kids and liked to stay buried in his books all the time (reading for pleasure - not sure if he's really into books or it's his "escape mechanism" to get out of whatever is going around that's over- or under-stimulating him at the time...

He's had some temper and emotional outburst issues at home on occasion for years - gets upset if things don't go the way he expects or if he starts to lose a board game, once cried for 10 minutes after his balloon popped and he insisted I needed to fix it, was playing legos with DS5 and when DS5 wanted to go out with me to play in the snow instead DS9 threw the legos across the room and destroyed what they were building - other things like that which aren't age-appropriate reactions any more...I've wondered if he's been depressed or if he's got anxiety issues going along with the Tourette's, or something else..

Since the teacher saw some abnormalities she thought were worth getting observed and I've seen things at home that were disconcerting, we went ahead with the BASC and I've got the report. I'll try to attach images but I'm not sure if it will work - if not, I'll add a summary.

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He's gifted, has issues summarizing and retelling but remembers little facts and details about what he reads, hates to write and still has horrible handwriting with a very awkward pencil grip (but it would be a beautiful violin bow hold!) and has fallen behind in reading- he came into the year at least at if not above grade level and teacher said if she hadn't given him some extra prompts he would have tested below grade level this last time around...

He'll go for his yearly well-child check in about 2 weeks and I will take the report with me, but I'd like advice on where do we go from here? Neurology, psychology, developmental pediatrician, someplace else? I don't believe the behaviors are related to the Tourette's (which was diagnosed by a pediatrician in our doctor's practice) but I could be wrong.. since it doesn't seem to cause him any issues at school or in life they don't even really follow him for it at all..

I need him to learn some coping skills that at school aren't books and at home aren't emotional outbursts. I fear that as he gets older one of the outbursts could get dangerous and he'll hurt someone (himself or someone else...) we're not there yet, but I don't want things to escalate to that point either...

Thanks for any help or advice you can give!!

I'd suggest requesting a referral for a neuropsychologist / educational evaluation. It's possible that what looks like attention challenges and withdrawal/anxiety could be caused by an underlying challenge. Not progressing in reading level through the year, avoidance of writing, odd pencil grip all sound like potential symptoms of *something* - possibly dysgraphia (pencil grip and avoidance of writing), possibly expressive language challenge (avoidance of writing and choosing reading over socializing), dyslexia (reading comprehension not moving up through the school year). A neuropsychologist takes a broad look at a child's developmental history, current level of ability/achievement, and overall academic functioning, and can help with putting together the pieces of the puzzle.


It's difficult to put together coping skills that will work successfully when you don't know what's causing the outbursts. Two things you can do while you wait for a referral and evaluation are to talk to your ds and ask him what he's feeling, what's happened, etc when he reacts. Second thing is to keep a journal/diary of outbursts, what ds was doing prior to the outburst, where it occurred, time of day etc - to look for patterns and triggers.

Good luck - let us know how everything goes.

polarbear

ps - I think if I were you I might consider calling your ped's office and asking if you can either move the well child check appointment earlier or write up a quick email re what's going on at school and ask them for advice now - we did that with our ds when he was 8 and he started having severe anxiety at school, and our ped referred us directly to a neuropsych without having to come in for a ped appointment. The wait for a neuropsych appointment can be quite long, and if you go that route, it would be great to get in asap, so you can know what you're dealing with and if needed put some accommodations/remediation in place over the summer, plus be prepared when school starts back up in the fall.

The other option is to make a request for a full IEP evaluation though the school. I think that between the BASC findings and the observations you've made about pencil grip, avoidance of writing etc you have good reasons to request an elibility evaluation. I'm not sure how much time is left in your school year, but the sooner you put in the written request the sooner the date by which the school is legally required to reply.

I'll add that, though the tics appear mild, it may be that his efforts to control them during the school day are exhausting all of his EF functions, which leaves him much more vulnerable to outbursts by the time he reaches home. You might consider investigating CBIT (cognitive-behavioral intervention for tics). Check the TSA website for info. Some CBT basics are also generally good for developing coping skills, especially where anxiety appears to be in play.

Thanks so much for the info guys. I did email a copy of the report and also some of my other observations to his pediatrician and asked if she thought a neuropsych referral would be appropriate, so we'll see where that goes.

Poor guy just got put on his third antibiotic in three months - this one for an ear/sinus infection. He had allergic reactions to the first 2 (one for strep and one for some weird toe infection) so I'm keeping my fingers crossed this med is tolerated ok. He just got released from the orthopedics after having a broken wrist last week, too. He's due for a karma break any time now!

And where he already has a documented Dx for TS, and school eval reports (the BASC) indicative of impacts from the disability, a 504 plan ought to be a shoo-in, if you don't already have one in place.

I'd echo the IEP eligibility eval request. Put it in writing, and the school must respond to you within 10 school days, with either a refusal to act (must explain why), or a request for consent to evaluate. Once you sign consent, the eval, meeting, and IEP development process must be completed within 60 calendar days, not including summer vacation:

http://odr-pa.org/parents/parent-resource-library/timelines/

So if you start the process now, the deadline will fall in the first month of the new school year.

If you prefer to have the PCP-referred neuropsych do the eval, then you might consider notifying the school that he has an upcoming eval, and then (most likely over the summer), putting the request for IEP eligibility determination, but entering the outside eval report into the process, so the school doesn't unnecessarily duplicate assessments. They may just accept the report, or supplement with a smaller selection (probably achievement testing), in which case, there is the potential for an expedited meeting in September.

Note that PA requires that an ID'd GT student must have his gifted needs addressed in the same IEP that addresses his other exceptionality(ies).

Interesting, my 10 year old son who has also been diagnosed with a tic disorder (very similar to Tourette's but apparently not Tourettes according to the psych who diagnosed him) is also allergic to an antibiotic.

From what I have learned from my own situation with my son, inattention and rage episodes can be part of Tourettes. Think of Tourettes as a filtering problem, and the mind has leaky brakes (like a car) and can't stop as easily as someone who doesn't have Tourettes. So normal things that you would want to inhibit don't always get inhibited. So if you get mad, it's hard to control it. If you get worried, it's hard to stop worrying. If you are bored, you have a hard time turning your mind away from things you enjoy thinking about instead and focusing on the boring subject. If you are thinking something that should probably be kept to yourself, whereas someone might not say what they are thinking, you will blurt it out.

There are children with just Tourettes (just tics) and there are children with TS+- basically Tourettes plus ADHD and/or OCD. There are other co-morbid conditions as well, separation anxiety is one. In addition there are apparently learning disorders too, although I haven't been able to pinpoint which ones can be part of the Tourettes profile.

If a child has ADHD with his Tourette's then he will often have poor working memory and/or slow processing speed.

I can also vouch for the fact that the combination of giftedness and tic disorder does seem to affect my son socially. Luckily he doesn't seem to care that much, he has his one best friend, and the rest can go hang.

Feel free to PM me if I can help in any way.

I just realized these two links might be helpful to you:

This link explains certain behaviors and how they are related to TS http://www.tsa-usa.org/Education/UnderstandingTSBehaviors.htm. Before he was diagnosed, I didn't understand why he did certain things, afterwards I started to understand.

This is a four hour (yes four hours!) talk that the foremost expert in TS gave a couple of years ago. It is worth listening to. If your son is 2e, you need to understand how his second e is affecting him. http://www.tsa-usa.org/aPeople/diagnosed/newly_diagnosed.html

Also as a pediatrician diagnosed him, you may want to take him to a psychiatrist (who truthfully often just want to treat with drugs, because they see it as a chemistry problem). I am not against drugs, I also see it largely as a problem with developmental chemistry- especially since they tend to grow out of it- but you can also see a neurologist. They may also recommend drugs. BUT if you just want help for teaching him how to cope- call your local TSA chapter. I'm not sure where you live, but I am equally sure there will be one near you. Contact them and ask them for any suggestions. There are also some good books on TS you can read that can help with parenting him. You cannot parent a child with TS like a normal child, nor can you parent a gifted child like a normal child. Both are an exercise in extremes. 2e what a ride

Anyway, I hope this is helpful.

AM Tuba- I just looked at the first link again (Understanding TS Behaviors) and you should definitely look at is as it describes what kind of learning disabilities can be part of TS. I hadn't looked at in a while, and I forgot it mentioned them as well.

Thanks! I'll check it out.

Pediatrician said there's no pediatric neuropsych at the hospital but gave some other options: developmental pediatrician, psychiatrist, behavior therapy, some pediatricians that do work more extensively with Tourette's patients. We're supposed to decide what we want to do before his appointment on 5/14.

You can also see if you can find a developmental psychiatrist.